Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review

Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1–2 in every 1000 deliveries. These episodes typically present as acute mania or depression with psychosis within the first few weeks of childbirth, which, as life-threatening psychiatric emergencies, can have a significant adverse impact on the mother, baby and wider family. The nosological status of postpartum psychosis remains contentious; however, evidence indicates most episodes to be manifestations of bipolar disorder and a vulnerability to a puerperal trigger. While childbirth appears to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum psychosis occurs are poorly understood. This review examines the current evidence with respect to potential aetiology and childbirth-related triggers of postpartum psychosis. Findings to date have implicated neurobiological factors, such as hormones, immunological dysregulation, circadian rhythm disruption and genetics, to be important in the pathogenesis of this disorder. Prediction models, informed by prospective cohort studies of high-risk women, are required to identify those at greatest risk of postpartum psychosis.

Postpartum psychoses

Guided by the views of various authors, the author of the article tries to systematize various etiological moments, both predisposing to postpartum psychoses and producing the latter. The first place among the causes is heredity, a predisposing cause. Between the predisposing and producing causes, as something transitional, there are emotional disturbances and moral upheavals. Finally, among the causative causes, it is necessary to indicate infection and postpartum diseases of the genital organs (especially often subinvolutio uteri), as well as autointoxicapia (eg eclampsia, osteomalacia).

On the issue of postpartum psychoses and, in particular, psychosis after eclampsia

It cannot be denied that the moments that weaken the body during both the act of childbirth itself and the postpartum period can, due to purely mental conditions, especially with the existence of a hereditary predisposition, entail mental illness in the postpartum period.

Perinatal depression and psychosis: an update

SummaryAbout 85% of women experience some type of postpartum mood disturbance. Generally, the symptoms are mild and short-lived, but a minority of women develop depressive illness or sudden psychosis. About half of episodes of apparently postnatal depression start during pregnancy and some seemingly postpartum psychoses start before delivery. Untreated antenatal depression can lead to poor obstetric outcomes, subsequent depression in the mother, and developmental disadvantage and depression later in life in the offspring. In this article we discuss the aetiology of perinatal depression and consider recommended pharmaceutical and psychosocial management of postpartum blues, perinatal depression and postpartum psychosis.